How a MaineCare expansion plan differs from past 5 failures

BDN file | BDN

BDN file | BDN

Gov. Paul LePage signs a veto letter he delivered to the Legislature instantly on May 23, 2013, after the Senate gave final passage to a bill that linked repayment of Maine's hospital debt with an expansion of Medicaid.

AUGUSTA, Maine — The Maine Legislature is about to embark — again — on another debate over whether the state should expand its Medicaid program under the provisions of the federal Affordable Care Act.

Sen. Tom Saviello, R-Wilton, teased his plan in December and is scheduled to release the details of his bill on Tuesday. Until then, Saviello isn’t talking about it other than to say expansion will benefit Maine in the long run.

“We can accomplish this task by learning from the other states that have extended this coverage,” said Saviello in a written statement Monday. “Increasing access to health coverage means increasing access to mental health counseling, drug addiction treatment and counseling and preventative health care, providing measureable cost saving and beneficial health outcomes across Maine.”

Little has changed since the five previous times since 2013 that legislators — mostly Democrats — tried but failed to expand Medicaid eligibility, notwithstanding vetoes from Gov. Paul LePage. Saviello’s fellow Republicans, who, in general, make up the opposition over fears that expanding Medicaid — known here as MaineCare — would be too expensive for future taxpayers, hold a majority in the Senate.

The new effort, sponsored by Saviello and backed by an array of progressive political groups and public health advocates, touts Medicaid expansion as a way for Maine to address a drug addiction crisis. And with a handful of Republican governors in other states changing their positions to allow Medicaid expansion, advocates say there is hope.

Here’s why:

Proponents framing this year’s version of expansion as a way to fight Maine’s drug crisis.

Ann Woloson, a policy analyst for Maine Equal Justice Partners, said Monday that she has not seen Saviello’s bill but understands that it samples from the highlights of other states’ expansion plans. Does that mean Medicaid expansion has a chance in Maine this year? Possibly.

“I do hope this year is different,” she said. “Substance abuse and addiction is not a partisan issue. It’s something that is affecting all of us.”

There is some evidence that expanding Medicaid under the Affordable Care Act — a plan under which the federal government has vowed to pay 90 percent of additional costs — eased costs in some other states’ criminal justice systems.

The State Reform Assistance Network, which is supported by the Robert Wood Johnson Foundation, is a proponent of expanding health care across the United States. The organization published a report in November that found Medicaid expansion in some states led to lower medical costs for treating prisoners, better drug relapse prevention rates when prisoners are released and lower recidivism.

The study claims that Colorado, Michigan and Ohio saw savings of $5 million to $13 million a year on criminal justice costs by expanding coverage that allowed low-income adults to access substance abuse and mental health treatment.

Democratic House Speaker Mark Eves of North Berwick said Medicaid expansion’s potential benefits in treating addiction could sway some lawmakers.

“What is different is that people are starting to make connections between the importance of Medicaid expansion and treatment as we fight the drug epidemic,” said Eves. “That is something that hasn’t been part of the conversation before and our law enforcement agencies tell us [expanding health coverage] is a critical piece of fighting this.”

Senate Minority Leader Justin Alfond of Portland said Saviello’s bill — though Alfond also hasn’t seen the details — uses a hybrid approach that melds signing up some Mainers for Medicaid while urging others to buy low-cost insurance on the private market.

“We’ve heard it all this session: Law enforcement and health care advocates all saying the same thing, that lack of access to health care is a barrier,” said Alfond. “Sen. Saviello is putting forth a new piece to the conversation. … I don’t know if that’s going to turn into votes or not but it’s definitely a different approach.”

But LePage is as opposed to it as ever.

Nobody’s more philosophically opposed to Medicaid expansion than LePage, and nothing has changed since his last veto.

He suggested they’re looking for votes in the 2016 election — even though the two moderates are among Maine’s safest legislators, each winning more than 70 percent of district votes in 2014 — saying he’ll veto such a proposal “every time electioneering politicians try to bring it up.”

LePage and his lieutenants have argued aggressively against expansion, not just in Maine, but nationally: Health and Human Services Commissioner Mary Mayhew has warned New Hampshire and Florida lawmakers against expansion.

“It was the wrong thing to do then,” the governor said in his radio address, “and it’s the wrong thing to do now.”

It looks like there’s no way for the Legislature to break that stalemate.

Medicaid expansion has passed the Legislature before, but two-thirds majorities are needed to overturn LePage vetoes. Democrats have never been able to wrangle enough votes to do so. The last time it was tried in 2014, LePage’s veto was sustained by just four votes.

But Democrats held both chambers then. Now, Republicans have control of the Senate and have gained on House Democrats, who have just a nine-member majority.

It’s likely that an expansion plan would pass in the House, where Democrats are aligned in favor. But Republicans have a 20-14 edge in the Senate with one vacancy, so if only Saviello and Katz join Democrats in favor of expansion, it’ll fail and won’t get to LePage.

Senate President Mike Thibodeau, R-Winterport, who has opposed expansion, said Monday that he hasn’t seen details of Saviello’s plan and wants to wait until then to comment on it.

But Thibodeau acknowledged the proposal’s political uphill battle, saying he’s waiting to see “what the significant difference is between what he’s proposing and what we’ve already seen.”

“Unless there’s something significantly different, I would say that it would be highly unlikely to gain traction,” he said.